The following is an excerpt of the piece with Segaran P. Pillai, Ph.D, MSc, SM (AAM), SM (ASCP), Chief Medical and Science Advisor for the Science and Technology Directorate in the U.S. Department of Homeland Security.

In 2001, I was the director of the Florida State Public Health Laboratory in Miami which responded to the first anthrax attack in the history of the United States. In that capacity, I was one of the lead investigators and worked in collaboration with members of the Centers for Disease Control and Prevention (CDC), Federal Bureau of Investigation (FBI), United States Postal Inspection Services (USPIS) and the Palm Beach County Health Department.

I was involved in the entire response to anthrax, from sample collection to testing and aiding the criminal investigation. In addition, I also helped create the process for medical countermeasure dispensation to the employees and visitors of the American Media Inc (AMI) building where anthrax exposure occurred.

During the response, I worked 18-20 hours a day for several weeks with my Assistant Director Dr. Peter Shih and other members who performed shift duties from the laboratory as well as members from the Miami Dade County Health Department . We worked tirelessly to ensure the public health mission was met. At times, when I headed back home to catch a nap, I would receive a call a couple of hours later relating to a high priority sample that required immediate testing. After a few instances, I and my Assistant Director Dr. Shih decided to catch little naps when possible at the office. We operated 24/7 because samples were coming in at all times throughout the day and laboratory testing was being conducted as they arrived.

The hardest part of dealing with the anthrax attack in 2001 was the lack of resources and personnel to support the excessive number of samples that ended up in the laboratories. This was due to the challenge for the First Responders to perform appropriate hazard assessments in the field to rule out potential threats. Most of these samples required immediate testing because of the fear associated with a biological threat agent that had a very high mortality and morbidity rate. In addition, the lack of robust laboratory processes and mechanisms to support high volume testing, the lack of appropriately trained laboratory scientists, the lack of available laboratory space to conduct high volume select agent testing contributed to the complexity and difficulties of the response.

Under new CDC grants and state-funded efforts, we now have fully trained laboratory scientists who can conduct high complexity tests on select agents. In the 10 years since the attack, 160 public health laboratories have become part of the CDC Laboratory Response Network (LRN).

The anthrax attacks also brought the public health, medical, law enforcement and first responder communities together. Quite simply, no single agency, office or team is capable of handling, responding or mitigating a biological attack. As such, the success stories of the 2001 anthrax attacks are the collaboration and coordination of activities among state and local public health members with law enforcement, first responders and the federal government. Even though we were extremely challenged in 2001, information was shared in a timely manner with all the critical members.

Today, the nation is better prepared to prevent an adversary from acquiring a biological threat agent, protect the critical infrastructure, rapidly detect an attack through robust surveillance and respond and recover from a potential biological attack.

My biggest concern is that the country is getting complacent and we might be losing focus on the importance of being prepared. We, as a nation, invested in building an infrastructure to ensure that the public health program is better prepared to respond to a biological attack. As time passes without an event and the budget continues to shrink, so does our ability to be fully prepared. The failure to maintain the infrastructure we have built can result in reverting us back to where we started.

>>Read the full piece by Segaran P. Pillaihere. View the full report from Trust for America’s Health and the Robert Wood Johnson Foundation here.

>>Read a Q&A with Anthony S. Fauci, M.D., Director of the National Institute of Allergy and Infectious Disease in the National Institutes of Health on the national response to the anthrax attacks here.

This commentary originally appeared on the RWJF New Public Health blog.